Acute Paediatric Tracheal Deviation and Neck Lump Secondary to Food Bolus Impaction.

Acute presentations of paediatric tracheal deviation secondary to neck masses are rare. The differentials are broad and the child may be compromised. Stabilising and resuscitating the child are the primary aims. This case describes a six-year-old boy with a history of neurodevelopmental delay and progressive dysphagia, presenting with an acute history of soft food bolus impaction, significant tracheal deviation and a firm neck lump. We discuss the diagnostic difficulties of the presentation, the work-up and the management of this rare case in the setting of a university hospital in the United Kingdom, with no paediatric intensive care on site.

Internal Jugular Vein Fenestration: An Intraoperative Finding Without a Radiological Clue.

A comprehensive understanding of the anatomical variations of the internal jugular vein (IJV) is essential to prevent inadvertent injuries during neck procedures, particularly neck dissection. In addition, its relationship with the spinal accessory nerve in the upper part of the neck is relatively variable. IJV fenestration refers to bifurcation of the vein with reunion proximal to the subclavian vein, whereas IJV duplication refers to continued branching till joining the subclavian vein separately. We report a case of a fenestrated IJV identified intraoperatively with the spinal accessory nerve passing laterally to both divisions.

Squamous Cell Papilloma of the Oesophagus: A Human Papilloma Virus Lesion.

Oesophageal squamous cell papilloma is a very rare entity with a limited number of reports in the literature. The exact aetiology is uncertain, and it commonly overlaps with gastro-oesophageal reflux. Human papilloma virus (HPV) is deemed responsible for some cases. Although incidental discovery during upper gastrointestinal endoscopy for other reasons is the commonest presentation, symptomatic cases do occur. Endoscopic excision is the standard treatment. We report a case of HPV-positive squamous papilloma of the upper oesophagus, presenting with lateralising throat pain and diagnosed with office transnasal oesophagoscopy. We also discuss features of HPV-positive oesophageal squamous papilloma and the role of transnasal oesophagoscopy as a recent diagnostic modality of increasing popularity.

Complicated sinusitis with sphenopalatine artery thrombosis in a COVID-19 patient: a case report.

COVID-19 has been a mystery against healthcare professionals. We herein report a rare presentation of complicated sinusitis with pre-septal cellulitis and hard palatal necrosis in a COVID-19 patient. A 52-year-old male was admitted to the hospital with typical COVID manifestations where he had two successive COVID-19 positive swabs. During his admission, he developed symptoms of right orbital complications of sinusitis along with both clinical and radiological evidence of ipsilateral hard palatal necrosis. Imaging confirmed a diagnosis of right pan-sinusitis complicated with right pre-septal infection and hard palatal bony defect on the same side. Our case focuses on the possible association between these manifestations and the known thromboembolic complications of COVID-19. Ongoing management of such complicated rare cases should be through multidisciplinary team.

Traumatic superior semicircular canal dehiscence syndrome: case report and literature review.

Superior semicircular canal dehiscence (SSCD) syndrome was first reported in 1998 by Minor et al. and comprises a spectrum of auditory and vestibular symptoms as a result of 'mobile third window' mechanism. The aetiology of SSCD is debated, but persistent infantile microstructure of the temporal bone was suggested. However, some authors related a 'second event', such as closed head trauma, temporal bone fracture and sudden increase in the intracranial pressure to the precipitation of its symptoms. In this article, we report a patient with a closed head trauma who developed unilateral auditory symptoms. High-resolution computed tomography images were obtained and confirmed bilateral SSCD with the normal middle ear structure. The patient was provided with a monaural hearing aid. Literature was searched for similar case reports or series where head trauma precipitated the symptoms of SSCD in anatomically susceptible individuals.

Double aortic arch: a rare cause of stridor in infants.

Double aortic arch is the most common vascular ring anomaly. It usually presents with symptoms related to tracheal and oesophageal compression. The constricting vascular ring may lead to stridor in infants and young children, which could be mistaken for upper respiratory tract infections or foreign body aspiration. It is therefore prudent to have a high index of suspicion when evaluating cases of paediatric stridor. Contrast-enhanced computed tomography and cardiac magnetic resonance imaging are the diagnostic modalities of choice to investigate vascular rings. We report a case of a stridulous infant with a double aortic arch.

Traumatic pseudoaneurysm of the cavernous carotid: a lethal complication of craniofacial trauma.

Pseudoaneurysm of the cavernous carotid artery is a rare, yet life-threatening complication of craniofacial trauma. It may well present itself with delayed massive epistaxis up to several months after the initial insult. Early recognition and prompt treatment are the key in management and a high index of clinical suspicion is always required. In this article, we report a patient with a penetrating head injury who developed delayed epistaxis along with unilateral abducent and partial oculomotor palsy. Urgent diagnostic carotid angiography was undertaken, followed by endovascular coiling that resulted in no recurrence for a year of follow-up.